Non-maleficence
The key concern is that individual patients might come to harm from switching inhalers. However, as outlined in the previous section, the diversity of the inhaler market means that a range of alternatives in the same class(es), that are likely to be equally effective, are available. It is worth noting that commissioning bodies have a history of mandating wholesale inhaler switching for populations, often for reasons of economy. It should be acknowledged that there is a degree of idiosyncrasy in response to inhaled medications, even in the same class, as well as variation in the ability to use a particular inhaler device. The objective is to avoid tobacco industry linked devices wherever possible rather than absolutely prohibit their use, to allow for the occasional instance where not using them would genuinely cause a deterioration in an individual patient’s condition.
People with lung disease, particularly where it is directly linked to smoking, are likely to want to avoid products that fund the tobacco industry as a matter of moral choice. There is evidence that patients consider environmental impact of treatments to be of importance.14 As one person with asthma writes; “2nd hand smoke has put me in ICU…I am not ok with using a device that is associated with a tobacco company .”15
Some individuals on tobacco-industry linked inhalers who are well-controlled may wish to remain on their current regime. The reasons for switching should be explained clearly, but they may not be reassured that other inhalers will be as effective. Some may have tried a range of inhalers previously before settling on their present regime. It is important to respect individual choices where possible.